Aging and Mixed Perturbation Training to Reduce Falls in Locomotion

Impaired or delayed reactive postural responses pose a potential threat to falls while
walking resulting in slips or trips in older and neurologically impaired individuals.
Therefore, increase in understanding of postural responses to unexpected external
perturbation in older adults and people with neurological diseases will lead to development
of new therapeutic approaches for fall prevention in this population. The overall objective
of this is to investigate the dynamic stability during slip and trip-like experiences by
evaluating the efficiency of recovery responses, retention and fall-risk reduction to slips
or trips induced during normal walking in healthy older adults. Participants will be
community dwelling ambulatory older adults between the age range of 60 to 90 years. Subjects
will be screened for the inclusion criteria. Subjects who qualify will go through clinical
balance assessment and dynamic stability training. The older adults will be divided into any
of the four groups -1) overground slip only training, 2) overground trip only training, 3)
overground combined slip + trip training, or 4) control (single slip + single trip). For both
overground slip/trip, all subjects' normal walking pattern and their recovery responses to
slip/trip will be recorded with a motion tracking system (including videotaping) while they
walk across an instrumented area along a straight path in the lab. A slip will be induced
after a subject steps on a low-friction platform. A trip will be induced by introducing an
obstacle device while the subject is walking, which consists of a hinged aluminum plate. At
12 months post-training session, the follow-up stability test will consist only of one slip
and trip induced on the training side and contralateral side. Incidence of falls and physical
activity will be monitored between training and re-test sessions through falls and activity
monitoring-questionnaire to describe details of the falls.

Inclusion Criteria:

- Community ambulators who use assistive device and are able to walk independently for
8m, healthy older adults between the age group of 60 to 90 years.

- Absence of any acute or chronic neurological, cardiopulmonary, musculoskeletal or
systemic diagnosis.

- No recent major surgery (< 6 months) or hospitalization (< 3 months)

- Not on any sedative drugs.

Exclusion Criteria:

- Subjects will be excluded if they report presence of pain, osteoporosis or any medical
conditions during telephone screening (see Telephone screening form). Also subjects
will be excluded if they are on osteoporosis medication, and narcotics/opioids class
of drugs under the sedative medications.

- Individuals classified as osteoporotic with heel bone density measurement with a
T-score < -2 using an ultrasound device.

- Individuals with mild cognitive impairment (Mini-mental State Exam score < 25/30)

- Complain of shortness of breath or uncontrolled pain (> 3/10 on VAS) or pulse oxygen
drops < 92% or are unable to achieve the age-specified minimal ambulation distance
during 6 minute walk test.

- Subjects with body weight more than 250lbs.